Creating an Environment of Potential

I.O. was born in 1989 during the tenth month of her mother's pregnancy. She was delivered with the umbilical cord was wrapped around her neck and suffered a heart attack. I.O. was "brain dead" (anoxic) for approximately eight minutes. Though she survived overwhelming odds at the beginning of life, complications were manifested in multiple medical and psychological circumstances as she grew. These included attention deficit disorder (ADD), depression, oppositional defiant disorder (ODD), sexual abuse, self-injurious behavior, learning disabilities, bipolar disorder, mild to moderate mental retardation, bilateral sensorineural hearing loss, seasonal affect disorder (SAD), complex partial seizure disorder, and cerebral palsy. Her social developmental was also impaired by inappropriate behaviors including violence toward others, elopement, and problems with the law.

In May 2007, the then 17 year old I.O. was admitted into the inpatient clinical/residential program at Centre for Neuro Skills® (CNS) in Bakersfield, California. Although she had been exposed to other programs, stabilization through consistent structure and appropriate neuromedical therapeutic intervention was still needed. It was anticipated that at least one year or more would be required to address multiple behavioral concerns to achieve greater independence in daily life. The initial phase of her clinical program involved six hours per day with speech, education, counseling, physical therapy and occupational therapy. The residential program included activities of daily living and community re-integration during evenings and weekends. I.O. frequently displayed non-compliant behavior and aggression toward herself and others during treatment. A consistent behavior program was designed to address her specific needs. This resulted in a change of more appropriate interactions, increased compliance in completing tasks and a decrease in self-injurious behavior.

After nine months of active treatment, I.O. transitioned into the long-term care program at CNS in the spring of 2008. This program is a therapeutically enriched environment providing daily activities to continue to enhance physical, mental, and social skills. While the program's therapeutic core continued to challenge these skills, I.O. had the perception that this aspect of therapy was "fun." However, it must be noted that she lacked an understanding of her continued need for therapy. Unlike the person who experiences a period of "normal" development before brain injury, I.O. began life and developed in a manner divergent from the world's perceived "norm."

While the focus of rehabilitation is typically on cognition, language, motor, and occupational skills, learning or re-learning the subtleties of social interactions are often overlooked. In I.O.'s case, the concern was that she looked like a young adult but there was a distinct difference between her chronological age and mental age. The rehabilitation or care team must keep this point constantly in mind while helping her to mature. Another issue to be considered is that persons with brain injury are very susceptible to social isolation. In most situations, long-term care programs are populated by older and mostly male adults. Therefore, the challenge to any program is to provide appropriate peer socialization that leads to social growth especially for the younger patient.

The lesson in I.O.'s case is that regardless of the latency and complexity of injury the potential for greater improvement remains unlimited when exposed to the right conditions. When I.O. entered the rehabilitation program at CNS in 2007, her life had been on a very troubled path with a likely future of more trouble with the law and possible psychiatric admissions. However, she blossomed and continues to advance in a challenging environment. What could her future hold? It is fair to say that continued exposure to a healthy rhythm of living within a structured and enriched environment can create unknown potential.